1. Quantification of 1,3-β-d-glucan by Wako β-glucan assay for rapid exclusion of invasive fungal infections in critical patients: A diagnostic test accuracy study
- Author
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Carloandrea Orcese, Stefania Torri, Claudia Alteri, Maria Cristina Moioli, Andrea De Gasperi, Alessandra Bielli, Laura Elisa Gasparini, Roberto Cairoli, Valeria Cento, Valentina Mancini, Milo Gatti, Valentina Lepera, Carlo Federico Perno, G. Lombardi, Paolo Brioschi, Massimo Puoti, Chiara Vismara, Jacopo Colombo, E. Mazza, Marco Merli, Cento V., Alteri C., Mancini V., Gatti M., Lepera V., Mazza E., Moioli M.C., Merli M., Colombo J., Orcese C.A., Bielli A., Torri S., Gasparini L.E., Vismara C., De Gasperi A., Brioschi P., Puoti M., Cairoli R., Lombardi G., Perno C.F., Cento, V, Alteri, C, Mancini, V, Gatti, M, Lepera, V, Mazza, E, Moioli, M, Merli, M, Colombo, J, Orcese, C, Bielli, A, Torri, S, Gasparini, L, Vismara, C, De Gasperi, A, Brioschi, P, Puoti, M, Cairoli, R, Lombardi, G, and Perno, C
- Subjects
0301 basic medicine ,Male ,Antifungal Agents ,beta-Glucans ,Predictive Value of Test ,deep fungal infection ,Gastroenterology ,surgery ,030207 dermatology & venereal diseases ,0302 clinical medicine ,Retrospective Studie ,Caspofungin ,Limit of Detection ,antimycotic chemotherapy ,Antifungal Agent ,Fluconazole ,Immunodeficiency ,chemistry.chemical_classification ,education.field_of_study ,Diagnostic test ,General Medicine ,Middle Aged ,Intensive Care Units ,Infectious Diseases ,peritoniti ,Female ,Human ,medicine.medical_specialty ,030106 microbiology ,Population ,Intensive Care Unit ,Peritonitis ,Dermatology ,Sensitivity and Specificity ,03 medical and health sciences ,systemic infection ,Predictive Value of Tests ,Internal medicine ,Intensive care ,medicine ,candidaemia ,Humans ,Invasive Fungal Infection ,education ,Glucan ,Aged ,Retrospective Studies ,business.industry ,Diagnostic Tests, Routine ,medicine.disease ,chemistry ,Voriconazole ,business ,1 3 β d glucan ,True positive rate ,immunodeficiency ,Invasive Fungal Infections - Abstract
Objectives: Rapid and reliable exclusion of invasive fungal infections (IFI) by markers able to avoid unnecessary empirical antifungal treatment is still a critical unmet clinical need. We investigated the diagnostic performance of a newly available β-d-Glucan (BDG) quantification assay, focusing on the optimisation of the BDG cut-off values for IFI exclusion. Methods: BDG results by Wako β-glucan assay (lower limit of detection [LLOD]=2.16pg/mL, positivity≥11pg/mL) on two consecutive serum samples were retrospectively analysed in 170 patients, admitted to haematological wards (N=42), intensive care units (ICUs; N=80), or other wards (N=48), exhibiting clinical signs and/or symptoms suspected for IFI. Only patients with proven IFI (EORTC/MSG criteria) were considered as true positives in the assessment of BDG sensitivity, specificity and predictive values. Results: Patients were diagnosed with no IFI (69.4%), proven IFI (25.3%) or probable IFI (5.3%). Two consecutive BDG values7.7pg/mL, could be a promising diagnostic approach to confidently rule out an IFI in both ICU and non-ICU patients. The poor specificity in the ICU setting remains a concern, due to the difficulty to interpret positive results in this fragile population.
- Published
- 2020